Provider Demographics
NPI:1851465603
Name:HUNTINGTON ORTHOPEDIC SURGICAL GROUP
Entity Type:Organization
Organization Name:HUNTINGTON ORTHOPEDIC SURGICAL GROUP
Other - Org Name:HUNTINGTON ORTHOPEDIC SURGICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BIRDI
Authorized Official - Middle Name:
Authorized Official - Last Name:SIERRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-795-0282
Mailing Address - Street 1:39 CONGRESS ST STE 200
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-3024
Mailing Address - Country:US
Mailing Address - Phone:626-795-0282
Mailing Address - Fax:626-795-0585
Practice Address - Street 1:39 CONGRESS ST STE 200
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105
Practice Address - Country:US
Practice Address - Phone:626-795-0282
Practice Address - Fax:626-795-0585
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HUNTINGTON ORTHOPEDIC SURGICAL GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-20
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAFNP31122204C00000X
CAA66450204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
6187830001Medicare NSC
W16482Medicare UPIN
CA6187830001Medicare NSC